go back

Maine rates for HCPCS L3640

Transfer Of An Orthosis From One Shoe To Another Dennis Browne Splint (Riveton) Both Shoes (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.30 / $30.86 / $30.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.22 / $58.58 / $108.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $29.70 / $29.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $36.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.52 / $26.52 / $36.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.17 / $41.17 / $41.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.63 / $30.86 / $30.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $23.01 / $23.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.89 / $25.37 / $58.33